Persistent methicillin-resistant Staphylococcus aureus bacteremia owing to placental abscess.

Abstract

Staphylococcus aureus as a pathogen in human gestational membranes, a rather rare phenomenon, has recently been the focus of several researches. S. aureus forms biofilms on these membranes and potentially causes chorioamnionitis in pregnant women. We report a case of persistent methicillin-resistant S. aureus (MRSA) bacteremia owing to placental infection, causing chorioamnionitis and preterm birth. A 29-year-old Japanese woman at the 27th gestational week was diagnosed with acute promyelocytic leukemia and underwent all-trans retinoic acid therapy. Soon after hospitalization, the patient presented with persistent MRSA bacteremia of unknown origin. Despite various antimicrobial therapies, she experienced 12 MRSA bacteremia episodes over 6 weeks. However, after child birth, MRSA bacteremia disappeared without any complications. A pathologic examination of her placenta revealed placenta abscess, resulting in a diagnosis of MRSA-associated chorioamnionitis. Molecular analysis proved that a single MRSA strain (SCCmec Type IVa), which tested negative for Panton-Valentine leukocidin and toxic shock syndrome toxin-1, caused the obstinate infection. We should be aware that persistent MRSA bacteremia in pregnant women can originate from placental abscess.

• Authors: Naomi Maeda, Hideharu Hagiya, Tsuyoshi Takiuchi, Shinsuke Kusakabe, Tetsuo Maeda, Keigo Kimura, Sayuri Iwai, Keisuke Kawasaki, Yumiko Hori, Eiichi Morii, Yuzuru Kanakura, Tadashi Kimura, Kazunori Tomono
• Journal: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy (J Infect Chemother) Vol. 24 Issue 12 Pg. 975-979 (Dec 2018) ISSN: 1437-7780 [Electronic] Netherlands
• PMID: 29804839 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2018 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Bacterial Toxins
• Exotoxins
• Leukocidins
• Panton-Valentine leukocidin
• Tretinoin

Topics

• Abdominal Abscess (blood, complications, diagnosis, drug therapy)
• Adult
• Bacteremia (diagnosis, drug therapy)
• Bacterial Toxins (genetics)
• Chorioamnionitis (blood, diagnosis, drug therapy)
• Exotoxins (genetics)
• Female
• Humans
• Leukemia, Promyelocytic, Acute (blood, diagnosis, drug therapy)
• Leukocidins (genetics)
• Methicillin-Resistant Staphylococcus aureus (drug effects, genetics)
• Pancytopenia
• Placenta (microbiology, pathology)
• Pregnancy
• Staphylococcal Infections (diagnosis, drug therapy)
• Tretinoin (therapeutic use)